To reveal the incidence and predictive parameters of occult cervical lymph node metastasis (LNM) in patients with cN0 laryngeal squamous cell cancer (LSCC) who underwent surgery as definitive treatment.
Methods:
Patients with cN0 laryngeal cancer who had undergone elective neck dissection together with partial or total laryngectomy between January 2006 and November 2020 were retrospectively analyzed. Clinical and histopathologic predictors of occult metastasis were also analyzed. Follow-up data were used to obtain recurrence and survival analysis.
Results:
A total of 86 patients with a mean age of 62.5 years were included in the study. Occult LNM was detected in 15 (17.4%) patients. Tumor grade, pT stage, thyroid cartilage invasion, and extralaryngeal extension were found to predict occult neck metastasis in univariate analysis. The mean follow-up time was 60.7 months and in the survival/recurrence analysis, pT stage, tumor location, tumor grade, presence of occult metastasis, pre-epiglottic space involvement. and extralaryngeal extension were found to predict poorer outcome.
Conclusion:
Overall occult LNM is low (17.4%) in N0 laryngeal cancer, but the presence of LNM is a poor prognostic factor. Correct determination of the neck status and proper treatment is crucial. The incidence of LNM is very low in T1–T2 stages and well-differentiated tumors. The “wait and see” strategy may be applied in T1–T2 cases as well as selected T3 cases with well-differentiated tumors.
BrayFFerlayJSoerjomataramI, et al. Cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin2018; 68: 394–424.
LeonciniEVukovicVCadoniG, et al. Clinical features and prognostic factors in patients with head and neck cancer: results from a multicentric study. Cancer Epidemiol J2015; 39: 367–374.
4.
CohenEELaMonteSJErbNL, et al. American Cancer Society head and neck cancer survivorship care guideline. CA Cancer J Clin2016; 66: 203–239.
5.
LaylandMKSessionsDGLenoxJ.The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope2005; 115: 629–639.
6.
OosterkampSde JongJMVan Den EndePL, et al. Predictive value of lymph node metastases and extracapsular extension for the risk of distant metastases in laryngeal carcinoma. Laryngoscope2006; 116: 2067–2070.
7.
MyersENFaganJJ.Management of the neck in cancer of the larynx. Ann Otol Rhinol Laryngol1999; 108: 828–832.
8.
WeissMHHarrisonLBIsaacsRS.Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg1994; 120: 699–702.
9.
EspositoEDMottaSCassianoB, et al. Occult lymph node metastases in supraglottic cancers of the larynx. Otolaryngol Head Neck Surg2001;124: 253–257.
10.
WaldfahrerFHauptmannBIroH.Lymph node metastasis of glottic laryngeal carcinoma. Laryngorhinootologie2005; 84: 96–100.
11.
HarrisonDFN. The pathology and management of subglottic cancer. Ann Otol Rhinol Laryngol1971; 80: 6–12.
12.
ChenLYWengWBWangW, et al. Analyses of high-risk factors for cervical lymph node metastasis in laryngeal squamous cell carcinoma and establishment of nomogram prediction model. Ear Nose Throat J. Epub ahead of print 2020 Feb. DOI: 10.1177/0145561320901613
13.
LevendagPVikramB.The problem of neck relapse in early stage supraglottic cancer: results of different treatment modalities for the clinically negative neck. Int J Radiat Oncol Biol Phys1987; 13: 1621–1624
14.
RamadanHHAllenGC.The influence of elective neck dissection on neck relapse in N0 supraglottic carcinoma. Am J Otolaryngol1993; 14: 278–281.
GüneyEYigitbasiOG.Management of N0 neck in T1–T2 unilateral supraglottic cancer. Ann Otol Rhinol Laryngol1999; 108: 998–1003.
17.
Redaelli de ZinisLONicolaiPTomenzoliD, et al. The distribution of lymph node metastases in supraglottic squamous cell carcinoma: therapeutic implications. Head Neck2002; 24: 913–920.
18.
PinillaMGonzalezFMLopez-CortijoC, et al. Management of N0 neck in laryngeal carcinoma: impact on patient’s survival. J Laryngol Otol2003; 117: 63–66.
19.
FiorellaRDi NicolaVFiorellaML, et al. “Conditional” neck dissection in management of laryngeal carcinoma. Acta Otorhinolaryngol Ital2006; 26: 356–359.
20.
RodrigoJPCabanillasRFrancoV, et al. Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1-T2 unilateral supraglottic cancer. Head Neck2006; 28: 534–539.
21.
CagliSYüceIGüneyE.Is routine inclusion of level IV necessary in neck dissection for clinically N0 supraglottic carcinoma?Otolaryngol Head Neck Surg2007; 136: 287–290.
22.
DeganelloAGittiGMeccarielloG, et al. Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer. Acta Otorhinolaryngol Ital2011; 31: 216–221.
23.
JiaSWangYHeH, et al. Incidence of level IIB lymph node metastasis in supraglottic laryngeal squamous cell carcinoma with clinically negative neck: a prospective study. Head Neck2013; 35: 987–991.
24.
MaHLianMFengL, et al. Factors contributing to lymph node occult metastasis in supraglottic laryngeal carcinoma cT2-T4 N0M0 and metastasis predictive equation. Chin J Cancer Res2014; 26: 7.
25.
DjordjevicVBukurovBArsovicN, et al. Prospective case-control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0). Clin Otolaryngol2016; 41: 634–639.
26.
LangroudiMMAmirzargarBAmaliA, et al. Rate of occult cervical lymph node involvement in supraglottic squamous cell carcinoma. Iran J Otorhinolaryngol2017; 29: 133.
27.
WangSXNingWJZhangXW, et al. Predictors of occult lymph node metastasis and prognosis in patients with cN0 T1-T2 supraglottic laryngeal carcinoma: a retrospective study. ORL J Otorhinolaryngol Relat Spec2019; 81: 317–326.
28.
HuCZhangMXueJ, et al. Analysis and management of occult cervical lymph node metastasis of cN0 supraglottic laryngeal carcinoma. J Clin Otorhinolaryngol Head Neck Surg2020; 34: 615–617.
29.
AmbroschPKronMPradierO, et al. Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Head Neck Surg2001; 124: 180–187.
30.
CandelaFCKothariKShahJP.Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck1990; 12:197–203.
31.
MnejjaMHammamiBBougachaL, et al. Occult lymph node metastasis in laryngeal squamous cell carcinoma: therapeutic and prognostic impact. Eur Ann Otorhinolaryngol Head Neck Dis2010; 127: 173–176.
32.
PaleriVKumar SubramaniamSOozeerN, et al. Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature. Head Neck2008; 30: 194–200.
LeónXQuerMOrúsC, et al. Selective dissection of levels II–III with intraoperative control of the upper and middle jugular nodes: a therapeutic option for the N0 neck. Head Neck2001; 23: 441–446.
